I983 Form Fillable – Fill Out and Use

SECTION 3: EMPLOYER INFORMATION (Completed by Employer)

Employer Name:			Street Address:			Suite:
Employer Website URL:			City:	State:	ZIP Code:
Employer ID Number (EIN):	Number of Full-Time		North American Industry Classification System(NAICS) Code:
	Employees in U.S.
OPT Hours Per Week (must be at least 20	Compensation
hours/week):	A.	Salary Amount and Frequency: ______________________________________
	B.	Other Compensation (Type and Estimated Amount or Value):
	1.	_______________________________________________________________
Start Date of Employment:	2.	_______________________________________________________________
(mm-dd-yyyy)_________________________	3.	_______________________________________________________________
	4.	_______________________________________________________________

SECTION 4: EMPLOYER CERTIFICATION

I declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my know ledge,

information and belief. I understand that the law provides severe penalties forknowingly and willfully falsifying or concealing a material fact, or using any false document in the submission of this form.

I certify on behalf of the employer that this Training Plan for STEM OPT Students (“Plan”) is approved and that:

1.I have review ed and understand this Plan, and I w ill ensure that the supervising Official follow s this Plan;

2.I w ill notify the DSO at the earliest available opportunity regarding any material changes to this Plan, including but not limited to, any change of Employer Identification Number resulting froma corporate restructuring, any reduction in compensation fromthe amount previously submitted on the Plan that is not tied to a reduction in hours worked, any significant decrease in hours per week that a student engages in a STEM training opportunity, and any decrease in hours below the 20-hours-per-week minimum required under this rule;

3.Within five business days of the termination or departure of the student during the authorized period of OPT, I w ill report such termination or departure to the DSO (Note: business days do not include federal holidays or w eekend days; and an employer shall consider a student to have departed w hen the employer know s the student has left the practical training opportunity, or w hen the student has not reported for practical training for a period of five consecutive business days without the consent of the employer); and

4.I w ill adhere to all applicable regulatory provisions that govern this program(see 8 CFR Part 214), which include, but are not limited to, the follow ing:

a.The student’s practical training opportunity is directlyrelated to the STEM degree that qualifies the student for the STEM OPT extension, and the position offered to the student achieves the objectives of his or her participation in this training program;

b.The student will receive on-site supervision and training, consistent w ith this Plan, by experienced and know ledgeable staff;

c.The employer has sufficient resources and personnel to provide the specified training programset forth in this Plan, and the employer is prepared to implement that program, including at the location(s) identified in this Plan;

d.The student on a STEM OPT extension will not replace a full- or part-time, temporary or permanent U.S. w orker. The terms and conditions of the STEM practical training opportunity—including duties, hours, and compensation—are commensurate with the terms and conditions applicable to the employer’s similarly situated U.S. w orkers or, if the employer does not employ and has not recently employed more than tw o similarly situated U.S. w orkers in the area of employment, the terms and conditions of other similarly situated U.S. w orkers in the area of employment; and

e.The training conducted pursuant to this Plan complies w ith all applicable Federal and State requirements relating to employment.

Note:DHS may, at its discretion, conducta site visit of the employer to ensure that program requirements are beingmet, includingthat the employer possesses and maintains the abilityand resources to provide structured and guided work-based learningexperiences consistent with this Plan.

Signature of Employer Official w ith Signatory Authority: ________________________________________________________________________

Printed Name and Title of Employer Official w ith Signatory Authority: _____________________________________________________________

Date: (mm-dd-yyyy) ______________ Printed Name of Employing Organization: _____________________________________________________

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Goals and Objectives: Describe how the assignment(s) w ith the employer w ill help the student achieve his or her specific objectives for work-based learning related to his or her STEM degree. The description must both specify the student’s goals regarding specific know ledge, skills, or techniques as w ell as the means by w hich they w ill be achieved.

Employer Oversight: Explain how the employer provides oversight and supervision of individuals filling positions such as that being filled by the named F-1 student. If the employer has a training program or related policy in place that controls such oversight and supervision, please describe.

Measures and Assessments: Explain how the employer measures and confirms w hether individuals filling positions such as that being filled by the named F-1 student are acquiring new know ledge and skills. If the employer has a training program or related policy in place that controls such measures and assessments, please describe.

Additional Remarks (optional): Provide additional information pertinent to the Plan.

SECTION 6: EMPLOYER OFFICIAL CERTIFICATION

Ideclare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my know ledge, information and belief. I understand that the law provides severe penalties forknowingly and willfully falsifying or concealing a material fact, or using any false document in the submission of this form.

Employer Officialwith Signatory Authority- I certify that:

1.I have review ed, understand, and will follow this Training Plan for STEM OPT Students (Plan);

2.I w ill conduct the required periodic evaluations of the student;*

3.I w ill adhere to all applicable regulatory provisions that govern this program(see 8 CFR Part 214.2(f)(10)(ii)); and

4.I w ill notify the DSO regarding any material changes to or material deviations fromthis Plan at the earliest available opportunity, including if I believe the student is not receiving appropriate training as delineated in this Plan.

Signature of Employer Official w ith Signatory Authority: ____________________________________________________________

Printed Name and Title of Employer Official with Signatory Authority:____________________________ Date: (mm-dd-yyyy) __________________

PRIVACY ACT STATEMENT

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AUTHORITIES: Section 101(a)(15)(F) of the Immigration and Nationality Act of 1952, as amended (INA), 8 U.S.C. 1101(a)(15)(F), Section 641 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, Div. C, 110 Stat. 3009-546 (codified at 8 U.S.C. 1372), Section 502 of the Enhanced Border Security and Visa Entry Reform Act of 2002, Pub. L. 107-173, 116 Stat. 543 (codified at 8 U.S.C. 1762) and Homeland Security Presidential Directive No. 2 (HSPD-2), authorize U.S. Immigration and Customs Enforcement (ICE) to collect the information requested in this form.

PURPOSE: The information collection on this form is used to assist in the administration of the STEM Optional Practical Training (OPT) extension so

that Designated School Officials (DSO) can properly recommend the Student for and review and help coordinate his or her STEM optional practical training opportunity.

ROUTINE USES: The information collected on this formmay be shared w ith: the individuals w ho signed the Plan, relevant DSOs acting as liaisons w ith the DHS, Federal, State, local, or foreign government entities for law enforcement purposes, Members of Congress in response to requests on the Student’s behalf, or as otherw ise authorized pursuant to its published Privacy Act systemof records notice - Privacy Act of 1974: U.S.

Immigration and Customs Enforcement, DHS/ICE-001 Student and Exchange Visitor Information System (SEVIS) System of Records (https://www.dhs.gov/system-records-notices-sorns).

DISCLOSURE: The information you provide is voluntary. How ever, failure to provide the information requested on this formmay delay or prevent participation in a STEM OPT opportunity.

PAPERWORK REDUCTION ACT

The public reporting burden for this collection of information is estimated to average 7.5 hours per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid Office of Management and Budget (OMB) control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, send them to: U . S . Immigration and Customs Enforcement, Office of Policy, 500 12th Street SW, Washington, D.C. 20536

*See evaluation forms that follow for student’s first evaluation, to occur before the one year anniversary of the start date of the student’s STEM OPT employment authorization, and final program evaluation.

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EVALUATION ON STUDENT PROGRESS

Provide a self-evaluation of your performance, using the measures previously identified, in applying and acquiring new know ledge, skills, and competencies identified in the Training Plan for STEM OPT Students. Discuss accomplishments, successful projects, overall contributions, etc., during this review period. Address whether there are any modifications to the objectives and goals for projects, or new areas for skill and competency development.

Range of Evaluation Dates: (mm-dd-yyyy): From __________ To __________

Must be submitted within the first 12 months of STEM Employment

Signature of Student: ___________________________________________________________________________________________________

Printed Name of Student: _____________________________________________________________ Date: (mm-dd-yyyy) ______________

Signature of Employer Official w ith Signatory

Authority:__________________________________________________________________________________

Printed Name of Employer Official with Signatory Authority: _______________________________________ Date: (mm-dd-yyyy) ______________

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FINAL EVALUATION ON STUDENT PROGRESS

Provide a self-evaluation of your performance, using the measures previously identified, in applying and acquiring new know ledge, skills, and competencies identified in the Training Plan for STEM OPT Students. Discuss accomplishments, successful projects, overall contributions, etc., during this review period. Address whether there are any modifications to the objectives and goals for projects, or new areas for skill and competency development.

Range of Evaluation Dates: (mm-dd-yyyy) From __________ To __________

To be submitted at the end of employment

Signature of Student: ___________________________________________________________________________________________________

Printed Name of Student: _____________________________________________________________	Date: (mm-dd-yyyy) ______________
Signature of Employer Official w ith Signatory Authority:________________________________________________________________
Printed Name of Employer Official with Signatory Authority: ______________________________________	Date: (mm-dd-yyyy) ______________

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